Provider Demographics
NPI:1902262884
Name:SCHNEIDER, BRYAN (ATC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 AVENUE OF CHAMPIONS
Mailing Address - Street 2:SMITH STADIUM WEST - RM 129
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-6412
Mailing Address - Country:US
Mailing Address - Phone:512-557-2645
Mailing Address - Fax:270-745-4261
Practice Address - Street 1:1605 AVENUE OF CHAMPIONS
Practice Address - Street 2:SMITH STADIUM WEST - RM 129
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6412
Practice Address - Country:US
Practice Address - Phone:512-557-2645
Practice Address - Fax:270-745-4261
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT11512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer